Special Announcements

Coverage Update: Sam’s Club Staying In Our Pharmacy Network

We’re pleased to announce that Sam’s Club will remain in our pharmacy network. Members can continue to fill prescriptions at Sam’s Club pharmacy locations without interruption to their coverage.

Members who recently filled prescriptions at Sam’s Club received letters informing them that the pharmacy would be leaving the network. New letters will be sent to these members letting them know that Sam’s Club will be staying in our pharmacy network.

Questions?

If you have any questions, please contact your account executive.

Dental Blue^® 65 Plans Will Include Enhanced Dental Benefits

Effective January 1, 2021, Dental Blue^® 65 plans will be expanded to include Enhanced Dental Benefits for at-risk members with qualifying medical conditions. We’ll provide eligible members with additional, condition-specific support, including full coverage for preventive and periodontal services that have been connected to improved overall health.

Enhanced Dental Benefits for Dental Blue 65 plans will include the following, outside of annual dollar limits and deductibles:

• Routine cleaning four times within 12 months
• Periodontal maintenance cleaning once every three months*
• Periodontal scaling once every 24 months*
• Oral cancer screening once every six months
• Fluoride treatment once every three months

For more information about these benefits, or if you have any questions, please contact your account executive.

*Available with plans that offer periodontal benefits; standard waiting periods apply.

Addressing Inequities in Health Care: Race and Ethnicity Data Collection on MyBlue

We’re dedicated to improving the quality of and access to care for everyone we serve. As part of our ongoing effort to address inequities in health care, we’re updating the MyProfile section of MyBlue to encourage our members to share information about their race, ethnicity, and language preference with us. This change will be effective January 1, 2021.

Sharing this information is voluntary. Choosing not to participate will not impact the coverage you or your employees receive from Blue Cross.

Advantages for You and Your Employees

With this data about our members, we’ll be better able to implement programs designed to reduce and eventually eliminate inequities in health care. This will help us toward our goal of improving the quality and efficiency of care, access to services, and health outcomes for all of our members.

Questions?

If you have any questions, please contact your account executive.

A Flu Shot Is Crucial for Members This Year

COVID-19 means it’s extra important for members to stay healthy during the flu season. Getting a flu shot helps keep members, their families, and communities safer during the pandemic. It can also keep members out of the hospital at a time when others desperately need critical care. Plus, getting a flu shot is safe, and available at no cost for members.*

Where Members Can Get a Flu Shot:

• Primary Care Provider
• Limited Service Clinics (such as CVS MinuteClinic®´)
• Urgent Care Centers
• Community Health Centers
• Public Access Clinics (available in some cities and towns, and may be available at no charge)
• Hospital Outpatient Departments
• Skilled Nursing Facilities, for members in outpatient care, like physical or occupational therapy
• Home Health Care Providers
• Certified Nurse/Midwife's Office
• Physician Assistant’s Office or Specialist Physician’s Office
• Nurse Practitioner’s Office
• Pharmacies

Members can visit bluecrossma.org/flu to learn more about the flu shot, and how to avoid getting the flu. They can also visit vaccinefinder.org to find out where the flu shot is available in their area.

For more information, talk to your account executive, or visit Blue IQ.

*When administered by an in-network provider. Exceptions may apply. Check plan materials for details.

Benefits of Choosing Indigo for Your Massachusetts Paid Family Medical Leave (MA PFML) Plan

Beginning January 1, 2021, most employers in Massachusetts, regardless of size, are required to provide paid family medical leave to their employees. Almost all employees are eligible to receive these benefits.

Administration of these benefits can be complex and time-consuming for employers. You can opt out of the state plan and save valuable administrative resources by choosing a private plan through one of Indigo’s partner carriers. Indigo Insurance^TM Services is the preferred agency of Blue Cross Blue Shield of Massachusetts for ancillary insurance. If you choose a private plan through Indigo, you’ll benefit from:

• Streamlined administration, including employer portals for billing, policies, and reports; efficient claims processing; and a coordinated approach to managing disability claims and leave.
• Expert consultation to ensure that you know your options, and have the necessary documents and policies to comply with the law.
• Team Blue Care Managers who offer enhanced support to members who use their disability or MA PFML benefits, helping employees return safely to work.
• Up to a .5% discount on your medical rates through the Pathway to Savings program, when you choose MA PFML plus one other line of group coverage through Indigo.

MA PFML provides up to 26 weeks of job-protected paid leave if employees are unable to work due to a serious health condition, or if they need to care for an ill or injured family member, bond with a new child, or manage family affairs when a family member is on active duty in the armed forces.

For more information, talk to your broker or Indigo account executive.

Updates to Blue 20/20 Member Website

We've refreshed the Blue 20/20 website, powered by EyeMed®´ Vision Care, an independent vision benefits company, to help our members more easily find information about their vision plan benefits. In addition to resources that help members locate an eye doctor or learn about eye health and wellness, the updated website includes new features, like:

• A savings summary that shows how much each member has saved on eye care by using Blue 20/20
• The abilities to adjust the website font size, and view the entire website in Spanish
• A reorganized navigation bar to access other helpful tools

Members can visit the new website at blue2020ma.com. First-time users will need to create a Blue 20/20 account.

If you have any questions, please contact your account executive.

Updates to Our Fitness Reimbursement

We want our members to get the most out of their benefits. That’s why we’ve added virtual fitness programs to our fitness reimbursement, so members can get reimbursed for fees paid for an online membership, subscription, or class that took place on or after January 1, 2020. We also offer an online reimbursement process, so it’s easier for our members to get rewarded.

Expanded Fitness Reimbursement

Effective January 1, 2020 for fully insured and available for opt-in for self-insured accounts, we’ve expanded our fitness reimbursement to include online fitness programs. Eligible members can now get reimbursed for:

• Membership fees at a full-service health club with cardiovascular and strength-training equipment like treadmills, bikes, weight machines, and free weights
• Fitness class fees at a studio with instructor-led group classes such as yoga, Pilates, Zumba®´, kickboxing, indoor cycling/spinning, and other exercise programs
• Fees for virtual/online fitness memberships, subscriptions, programs, or classes that provide cardiovascular and strength-training using a digital platform

Online Submission for Reimbursement

We created an online reimbursement process that lets members easily and conveniently submit their reimbursement request via MyBlue.

If you have any questions, please contact your account executive.

Protect Your Organization from Wire Fraud

Blue Cross Blue Shield of Massachusetts is committed to keeping our accounts’ financial information safe and secure. We’re sharing these best practices to help you identify potential wire fraud and protect your organization from fraudulent activity.

If you suspect you’ve received a fraudulent email or call related to sensitive banking information, call your Blue Cross Customer Financial Management receivables analyst or your account executive. You can also report suspicious activity to our fraud hotline at 1-800-992-4100, or fraudhotline@bcbsma.com.

If you have any questions, contact your account executive.

Introducing Our Plan Comparison Tool

We’re excited to announce the launch of our updated plan comparison tool. With this tool, you can view and compare up to three plans including the corresponding SOB, SBC, and Benefit Change Fact Sheet (if applicable).

Our new plan comparison tool features:

• An updated look and feel
• The same functionality
• All plans on one page
• Easier navigation to remove a plan and add a new plan into the comparison

Get started now with the plan comparison tool

Introducing Our Account Webinar Series

You asked and we listened! Blue Cross Blue Shield of Massachusetts is excited to host live webinars, featuring subject matter experts and designed to help your organization’s leaders and human resources team learn more about your health plan benefits, so you can better work with your brokers to make benefit decisions and ensure your employees get the most from their health plan.

We’ll announce additional webinars each month, and presentations will last approximately one hour. Topics will include:

• New Blue Cross plan features
• Managing pharmacy benefits
• Blue Cross ancillary product offerings
• The benefits of Blue Cross Care Management

Register for an upcoming webinar

If you have any questions, please contact your account executive.

No-Cost Online Behavioral Health Seminars

We’re offering live, online seminars each month, at no additional cost, to help our members cope with feelings of stress, anxiety, and grief, as well as other behavioral health issues, during these unprecedented times.

Blue Cross Blue Shield of Massachusetts Senior Medical Director Dr. Ken Duckworth, and psychologist and member of the Blue Cross Physician/Psychologist Review Unit Dr. Alan Cusher, will lead each seminar and share resources available to support our members and their families. Presentations will focus on topics like grief and loss, dealing with anxiety about going back to school, and more. Members will be able to submit questions before and during the seminar.

To view upcoming seminars, and learn how our members can register, visit our Online Behavioral Health Seminar page. If you have any questions, please contact your account executive.

Quality Care Cancer Program Launching in 2021

We’re launching our new Quality Care Cancer Program on July 1, 2021, to help ensure that our members receive cancer care that is appropriate and safe, based on clinical guidelines. Through the Quality Care Cancer Program, board-certified oncologists and oncology-trained nurses will be available to discuss covered treatment options with our members’ doctors.

Our Quality Care Cancer Program applies to all commercial and Medicare Advantage plan members seeking outpatient medical oncology treatment (chemotherapy, immunotherapy, and supportive medications), or outpatient radiation oncology treatment. Doctors who order these types of treatments for our members will request Prior Authorization through AIM Specialty Health®´ (AIM), an independent company that will administer this program.

When a member’s oncology care team submits a treatment plan for Prior Authorization that meets evidence-based clinical criteria for the cancer being treated, the member’s doctor will get real-time approval. If the requested treatment doesn’t meet evidence-based criteria, the member’s doctor can request a peer-to-peer consultation with an AIM oncologist to discuss the covered, evidence-based treatments that are best for the member.

For a member already receiving cancer treatment at the time of the Quality Care Cancer Program’s launch, their doctor will need to request a Prior Authorization for the continuation of coverage. If a member’s treatment plan changes, their doctor will then request a new Prior Authorization for health plan coverage.

Because scientific and medical advances are rapidly changing cancer treatment, and there are wide variations in the way doctors treat patients with the same type of cancer, cancer care quality programs like ours are becoming necessary.

The Quality Care Cancer Program is designed to help our members receive the most appropriate and effective treatment regimen, so they can have the best possible outcome with the least number of side effects. If you have any questions, please contact your account executive.

Acceptable Enrollment Formats for New Business One Time Files

When submitting new business enrollment files, it’s important to submit them in the required format to populate your data. This ensures an accurate enrollment experience and avoids delays. If you have a plan that includes a personal spending account (PSA), please use the New Business Enrollment Template with PSA information. If you don’t have a plan that includes a PSA, please use the New Business Enrollment Template.

Please note that we are unable to manipulate or alter any data that has been submitted (e.g. adding group numbers, PCP info, PSA info, etc.). This is consistent with industry standards and complies with the rules and regulations of Blue Cross Blue Shield Enrollment and Auditing Guidelines.

As always, if you have questions, your Implementation Specialist will be happy to assist you.

Member Months Coverage Report Available for ASC Accounts at No Cost

We’re offering a Member Months Coverage Report to our ASC accounts for the 2020 tax year at no cost. This information is required by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor, and filing the data with the IRS.

The Member Months Coverage Report will be delivered using Secure File Transfer Protocol (SFTP), and posted in January, 2021. This security measure enhances our ability to safeguard the personal information that’s included in these reports.

What’s Included in the Report

The Member Months Coverage Report contains data for each member enrolled for at least one month in one of our insurance plans. The report is required to include:

• Account number
• Group number
• Member number
• First, middle, and last name
• Member suffix
• Member Social Security Number (SSN)
• Date of birth
• Months covered for each member
• Dependent status
• Member insurance ID
• Member Taxpayer Identification Number (TIN) type
• Member TIN type
• Subscriber SSN
• Subscriber address

We won’t be soliciting SSNs. We’ll rely on accounts to update this information through the electronic enrollment file process or BluesEnroll prior to January 1, 2021.

Request a Report

To request a Member Months Coverage Report, please inform your account executive before November 1, 2020.

SFTP Account Access and New User Requests

Please confirm that your previous year recipients SFTP account is still active. If the user has not accessed their account in the past 90 days, please contact your Account Executive to request a password reset prior to January 1, 2021.

If you have a new user is request, please provide the following information to your Account Executive by November 1, 2020 for a SFTP account to be created:

• Contact Name, First and Last (for who should receive this report)
• Company
• Email Address
• Telephone Number

Important Disclaimer Added to ID Cards for HMO Blue New England Plan Members

We’ve added new language to the back of member ID cards, informing HMO New England plan members about the limited availability of benefits outside of New England. We started sending new cards to all current members on June 1, 2020. Going forward, all new HMO New England plan members will receive the updated cards. If you have any questions, please contact your account executive.

Well Connection Now Offers Psychiatry Care

Well Connection is expanding its behavioral health services to include video-based psychiatry. With this new service, board-certified psychiatrists provide medication management for behavioral health conditions. The psychiatrists can evaluate health, assess the benefits of medications, and prescribe them.

With Well Connection’s psychiatry services, we seek to:

• Bring care to the member’s location such as a member’s home
• Help integrate behavioral health care and primary care
• Reduce delays in care or time off from work

Well Connection provides convenient, secure, personal access to medical and behavioral care 24/7, using a computer, tablet or smartphone. Members with the telehealth benefit can register for Well Connection at wellconnection.com or download the app to schedule an appointment.

Important Surveys for Employers: Medical Loss Ratio and Employer Group Size

In July, fully insured Blue Cross Blue Shield of Massachusetts accounts will receive one or both of the surveys described below in the mail. It’s important that our accounts respond in a timely manner so that we can determine if an account is eligible to receive a rebate for reporting year 2020 (issued in 2021), and ensure that our members’ claims are properly processed. We encourage you to remind your accounts to respond promptly.

• The Patient Protection and Affordable Care Act (PPACA) survey helps us accurately calculate Medical Loss Ratio (MLR) for the small- and large-employer group segments. If our MLR standards aren’t met, we issue premium rebates to the applicable market segment(s).
• The federal Medicare Secondary Payer (MSP) survey allows us to annually track the total number of employees in each of our accounts, not just those who are enrolled in Blue Cross Blue Shield of Massachusetts plans. This helps us determine whether Medicare or an employer group health plan is responsible for paying employee’s health claims first.

Account Type	Survey
Accounts with 125 or fewer enrolled employees	The Patient Protection and Affordable Care Act (PPACA) survey The Medicare Secondary Payer (MSP) survey
Accounts that canceled Blue Cross coverage in 2019	The Patient Protection and Affordable Care Act (PPACA) survey

 

If you have questions, please contact your account executive. For more information about these surveys, medical loss ratios, or Medicare Secondary Payer rules, please see:

• Frequently Asked Questions—PPACA
• Frequently Asked Questions—MSP

How to Help Transition Eligible Employees to a Medicare Plan

You can customize your own Medicare handout by simply adding your company’s logo. This professionally designed flyer will inform both upcoming and late retirees on how to get started, so they can decide which plan is right for them.

You can also direct them to learn more by visiting our Medicare Options website at bluecrossma.com/medicare. They’ll be able to review their plan options, sign up for a Medicare seminar, or download a free Medicare Guidebook. They can also talk to one of our Medicare experts by calling 1-800-678-2265 (TTY: 711), 8:00 a.m. – 8:00 p.m. ET, April 1 through September 30, Monday through Friday, or October 1 through March 31, seven days a week.

To learn more or to request your own personalized version, talk to your account executive.

Changes to Dental Maximum Liability

Effective January 1, 2020, members with a Blue Cross dental plan may only be charged up to the fee schedule amount for additional covered services, according to the in-network dental provider’s contracted fee schedule, even after reaching their benefit maximums. This includes:

• Annual maximums (calendar year and plan year) and orthodontic lifetime maximums
• Time limits
• Frequencies

Previously, members may have been billed for the provider’s charge beyond the fee schedule amount when they received care after reaching their maximum. This change enhances the member experience by providing more value and making needed care more affordable.

If you have any questions, please contact your account executive.

Blue Cross Blue Shield of Massachusetts Surpasses Medical Loss Ratio Requirements for 2019

In 2019, more than 90 cents of every premium dollar paid to Blue Cross went toward covering medical expenses for our members. This exceeded both state and federal medical loss ratio standards for all regulated market segments. As a result, we will not be issuing rebates for 2019.

The Patient Protection and Affordable Care Act requires insurers to meet specific medical loss ratio standards. For large groups, at least 85 percent of every premium dollar must go toward medical expenses. For small groups, individuals, and merged market accounts, Massachusetts law sets the standard at 88 percent, which is higher than the federal standard of 80 percent. If an insurer’s medical loss ratio is below the requirement, they must issue rebates to their members.

Learn more about medical loss ratio at www.healthcare.gov or www.mass.gov.

Important Employer Surveys: Medical Loss Ratios and Employer Group Size

In July, employers with a fully insured, premium financial arrangement with Blue Cross Blue Shield of Massachusetts will receive at least one of the following two surveys in the mail. This year, we have emphasized to our accounts that a timely response to both surveys is essential for two reasons. First, it helps us determine if the company is eligible to receive a rebate for 2020 (if any are required to be issued in 2021). Second, it ensures that employees are enrolled correctly, and their claims are properly adjudicated along MSP guidelines. We appreciate your support as you encourage your accounts to respond promptly.

About the PPACA survey

The Patient Protection and Affordable Care Act (PPACA) survey allows us to accurately calculate medical loss ratios for the small- and large-employer group segments. If medical loss ratio standards are not met, premium rebates would be issued to the applicable market segment(s). We use this data, along with other components, to determine if we will need to issue rebates.

About the MSP survey

The federal Medicare Secondary Payer (MSP) survey allows us to annually track the number of employees each company has. This includes all employees, and is not limited to those associated with employers’ Blue Cross Blue Shield of Massachusetts accounts. This will help us determine whether Medicare or an employer group health plan pays for an employee’s health claims first.

If you have questions, please contact your account executive.

Coverage of Opioid Alternatives, and Change in Massachusetts’ “Partial Fill” Law

For members who prefer not to use opioids for pain management, our standard plans cover a wide range of alternative treatment options, including more than 500 non-opiate medications (nonsteroidal anti-inflammatory drugs, and topical analgesics).*

We also cover several specialty services, combining therapies to offer individualized treatment for pain management, including:

• physical and occupational therapy (PT/OT)
• chiropractic treatment
• pain-medicine specialists
• transcutaneous electrical nerve stimulation (TENS) units
• acupuncture (beginning January 1, 2020 for new or renewed plans)

We’ll be adding an Alternatives to Opioids section to the Medication Lookup tool by the end of December. That’s where members will find an Alternatives to Opioids fact sheet and medication list.

Also, due to a recent change in Massachusetts’ “partial fill” law, there’s no extra charge for members who choose to partially fill their narcotic or opioid prescription. These members won’t be charged an additional copay if they fill the remainder of the prescription at the same pharmacy within 30 days.

*For more information about coverage for non-opiate medications, members should check their pharmacy benefit materials. For covered pain management services, they should check their medical benefit materials. 

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New Online Behavioral Health Resource – Learn to Live

Our new innovative online resource provides support for members who are struggling with depression, insomnia, stress, and anxiety. Learn to Live provides online, self-directed programs and self-assessments based on the principles of Cognitive Behavioral Therapy for employees and their family members (ages 13 or older). Learn to Live is available as a buy-up to employers with 500+ subscribers and complements our market-leading behavioral health program, which combines the largest network of behavioral health providers in Massachusetts. It's also the newest addition to the Emerging Solutions portfolio. Blue Cross introduced Emerging Solutions to curate innovative digital solutions and provide employers with options to help improve their employees' health.

Learn to Live offers:

• Proven outcomes (30%+ drops in psychometric measures)
• Confidential, self-directed programs offering tools and educational resources
• Personalized coaching available 24/7
• No technical integration required
• Turnkey awareness and engagement campaigns
• Robust data analysis and utilization tracking

For more information about Learn to Live, contact your account executive.

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No-Cost Flu Vaccine Available for Members

We’re committed to limiting the spread of the flu this season. That’s why there is no cost to the member for the flu vaccine when administered by a participating or preferred health care provider, such as a doctor or nurse practitioner, or at an urgent care center, limited services clinic, or pharmacy-based clinic (like CVS MinuteClinic^®’).

The flu vaccine is updated annually to most closely match the current strain of the virus. We cover all flu vaccines recommended by the Centers for Disease Control and Prevention during the 2019–2020 flu season, for members aged six months and older.

The flu can spread quickly and easily, with germs traveling up to six feet away from the infected person. When members get a flu vaccine, they’re protecting themselves and those around them from the virus. Members should ask their doctor if the flu vaccine is right for them.

For more flu-related information, click here

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Updated List of 2020 Plans Impacted by Member ID Card Distribution Changes

As communicated in the October 2019 IAI, we recently changed the timeline for when we send new member ID cards to Small Group (under 50) accounts that have members in certain plans. The list of plans affected by this update is subject to change annually, and the plans below reflect the impact for the 2020 renewal year:

• Blue Select^® $1,000 Deductible
• HMO Blue Basic
• HMO Blue Basic Deductible
• HMO Blue New England Premier Value Calendar Year
• HMO Blue New England Premier Value Plan Year
• HMO Blue New England $500 Deductible with Hospital Choice Cost Sharing (HCCS)
• HMO Blue New England $1,000 Deductible Calendar Year
• HMO Blue New England $1,000 Deductible Plan Year
• HMO Blue New England $1,000 Deductible with HCCS
• HMO Blue New England $1,000 Deductible with Copayment
• HMO Blue New England $1,500 Deductible with HCCS
• HMO Blue New England $2,000 Deductible
• HMO Blue New England $2,000 Deductible with HCCS
• HMO Blue New England Saver $2,000
• HMO Blue New England Saver $3,000 with HCCS
• HMO Blue New England Premier Value with HCCS
• HMO Blue Saver
• HMO Blue Select $1,000 Deductible with Copayment
• HMO Blue Select $2,000 Deductible
• HMO Blue Select Saver $2,000
• Preferred Blue® PPO $500 Deductible with HCCS

As a reminder, we’ll send new member ID cards to members on these plans 15 days before their plan’s benefits change, or their renewal date is effective, as long as their plan hasn’t been canceled for the coming benefit year. If an account makes a benefit change within 15 days of their renewal effective date, members may receive two sets of new member ID cards. This change will ensure members receive updated member ID cards in a timely manner.

If you have any questions, please contact your account executive.

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Pathway to Savings Now Includes Massachusetts Paid Family and Medical Leave (MA PFML) Products

We’re excited to announce the expansion of our Pathway to Savings program to include

MA PFML-compliant products, through our preferred carriers with Indigo Insurance^TM Services. When you choose a MA PFML-compliant plan with one of Indigo’s preferred carriers (USAble, Hartford, AXA, or Symetra) plus one other group line of coverage, you’re eligible to receive .5% off your medical rates for the first year, and .25% off your medical rates for the second year.*

If you’re interested in purchasing a MA PFML-compliant plan through a private insurance company, you’ll need to file for an exemption from the state plan.

To learn more about available options through our preferred carriers and filing for the exemption, please contact your broker.

Go here for more information about the new MA PFML program.

*This discount is available for accounts with 51+ eligible lives.

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Members Can Go Paperless

Very soon, members with commercial medical, dental, or Medex^®´ plans can choose whether they want to continue receiving claim summary statements (Summary of Health Plan Payments, and Explanation of Benefits) on paper, or go green and view them online using MyBlue. A small subset of members that have already opted into receiving email communications will be going paperless in Q1 2020. They will be provided the option to continue to receive paper claim summary statements if they choose. 

We’re making this change to provide a better experience for our members who want to go paperless. It will also help the environment by reducing waste and clutter. Members can choose from additional documents that we’ll be adding soon. Watch for more information.

If you have any questions, please contact your account executive.

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An Easier Way for Members to Manage Their Maintenance Medications

Managing more than one maintenance medication can be complicated and time-consuming. With PillPack, a full-service, in-network pharmacy, members won’t have to worry about going to the pharmacy, organizing their medications, or missing a dose again. That’s because PillPack presorts their medications by day, date, and time, then delivers them to their door in clearly-marked packets, so members know which pills to take and when—giving them more time to focus on other important things in their lives. PillPack will be available only for fully insured accounts, starting October 22, 2019.

Benefits of PillPack:

• There’s No Additional Cost for This Service, Not Even for Shipping

  There’s no additional out-of-pocket cost associated with the service, not even for standard shipping. Members are only responsible for paying their copay, which is the same cost they’d pay at a retail pharmacy.

• Members Can Save on Qualifying Over-the-Counter Medications

  Members can also add certain vitamins and over-the-counter medications to their order. Some qualify for a discount when ordered through PillPack.

• Hassle-Free Refills

  Prescriptions are refilled automatically and delivered to their door on time every month.

• Pharmacists Are Available 24/7

  If members have questions about their medications, they can talk to a pharmacist any time, by calling PillPack at 1-855-745-5725.

How It Works

1. Members can sign up through their MyBlue account
2. Members choose which medications they want delivered
3. PillPack works with their doctor and pharmacist to transfer their prescriptions
4. PillPack sorts medications by day, date, and time, then ships them to the member each month

Questions?

If you have any questions about this service, please contact your broker or account executive

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Exclusive Savings and Rebates for Blue 20/20 Members

Blue 20/20 members can now take advantage of exclusive savings, discounts, and rebates on eye care products and services. New and updated offers are added quarterly and annually, helping members save on out-of-pocket costs. Members can log in to their Blue 20/20 account at blue2020ma.com, and go to the Special Offers* page to see what’s new.

*Restrictions may apply.

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Get Your Employees to Participate in Drug Take Back Day on October 26, 2019

Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. Encourage your employees to go through their medicine cabinets and check for any expired or unwanted medications—this includes everything from aspirin to prescription medications.

The U.S. Drug Enforcement Administration’s next National Prescription Drug Take Back Day is Saturday, October 26, 2019, from 10:00 a.m. to 2:00 p.m. Anyone can take part by bringing expired or unused medications to a local disposal location.

Your employees can use the U.S. Drug Enforcement Administration's search tool to find Take Back locations in their area.

Enhancements to Our Find a Doctor & Estimate Costs Tool

As part of our ongoing efforts to improve the Member experience, we’ve made our Find a Doctor and Estimate Costs tool available within MyBlue. This update, launched September 2019, improves the way a Member can search for a doctor, dentist, specialist, or other health care provider, as well as estimate the cost of a service or procedure.

Members can take full advantage of the tool’s offerings by creating or signing in to their MyBlue account. Members with customized networks and those eligible for SmartShopper will continue to use the existing tool.

Members can:

Questions?

If you have any questions, please contact your account executive.

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Enhancements to the MyBlue App

Throughout 2019, we’ve been making several enhancements to the MyBlue App that offers our members a better user experience, improved performance, and full integration with the MyBlue website.

This includes:

Questions?

If you have questions, please contact your account executive.

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Introducing ScreenRx^®´ for Self-Insured Accounts

ScreenRx identifies members who are more likely to stop taking medications, and reaches out to them with support, education, and a tailored adherence plan so they can stay on track. This program will be available to self-insured accounts beginning January 1, 2020, and will be managed by Express Scripts^®´, an independent company that administers our pharmacy benefit.

How It Works

ScreenRx uses claims data, behavioral science, and clinical specialization to identify members with chronic conditions who are at risk to be non-adherent with their medications. Members may be eligible if they take a medication in a targeted drug class or to treat a certain condition.* See the table below for more information.

Targeted Drug Classes	Targeted Conditions
Anticoagulants	Asthma
Statins	COPD
	Depression
	Diabetes
	Hypertension
	Osteoporosis

When members are identified, a specialized pharmacist contacts them by phone, email, or through the Express Scripts website or app. The pharmacist talks with them about barriers that could make them non-adherent, then recommends a tailored health care plan to overcome those barriers. When members take their medications properly, they reduce medication waste and help lower future medical costs by improving their long-term health.

The Savings Typically Outweigh the Costs

Savings associated with ScreenRx are typically equal to an account’s initial investment, with the potential to save even more.**

Questions?

Please contact your account executive.

* Current targeted drug classes and conditions are subject to change.
** Contact your account executive for more details on savings.

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Introducing RationalMed^®´ for Self-Insured Accounts

RationalMed improves patient health by identifying gaps in care and providing medication safety interventions. This program will be added as a core benefit at no cost for self-insured accounts with the Blue Cross Blue Shield of Massachusetts formulary effective January 1, 2020. RationalMed will be managed by Express Scripts®´, an independent company that administers our pharmacy benefit.

How It Works

RationalMed combines medical, pharmacy, and laboratory data to create an integrated patient profile. Each profile is analyzed and reviewed against thousands of evidence-based clinical rules, identifying potential safety and health risks across the following three categories:

When risks are identified, RationalMed alerts the member’s doctor and pharmacist. This safety solution initiates changes to improve the member’s health and correct errors in care.

The Benefits of RationalMed

Questions?

Please contact your broker or account executive.

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Smart90^®´ Now Included in Core Benefits for Self-Insured Accounts with Pharmacy Benefits

Starting January 1, 2020, upon renewal, self-insured accounts* with pharmacy benefits will include the Smart90 program, which allows members to get a 90-day supply of certain maintenance medications through the mail order pharmacy, or from the more than 9,800 CVS Pharmacy^TM retail locations nationwide.

Filling a 90-day supply instead of three 30-day supplies saves your employees time and money. They’ll make fewer trips to the pharmacy and their out-of-pocket costs will be lower. Plus, they’ll have the convenience to get their prescriptions where they want.

*Self-insured accounts with Select Home Delivery, Exclusive Home Delivery, or Smart90 implemented before January 1, 2020 will be excluded from this change. All other accounts will get the Smart90 program unless they ask to opt out.

Questions?

If you have any questions, please contact your account executive.

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Upcoming Changes to Member ID Card Distribution

As part of our ongoing commitment to better serve our accounts and members, we’re changing the timeline for when we send new Member ID cards to Small Group (under 50) accounts that have members in the following plans:

New Member ID cards are required because we have incorporated new benefits into these plans. Currently, we send new Member ID cards to members after their plan’s benefits change or their renewal date is effective. For the remainder of 2019, we’ll send new Member ID cards to members on the plans listed above 15 days before their plan’s benefits change or their renewal date is effective, as long as their plan hasn’t been cancelled for the coming benefit year.

This change will ensure members receive updated Member ID cards in a timely manner. The list of plans affected by this update will change in 2020, and members will be notified if their plan is affected.

Note: If an account makes a benefit change within 15 days of their renewal effective date, members may receive two sets of new member ID cards. 

If you have questions, please contact your account executive.

MyBlue Digital ID Card

Members can get instant access to a digital copy of their member ID card at bluecrossma.com/myblue, or by downloading the MyBlue App from the App^®´ Store or Google Play^TM.

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New Federal Medicare Mandate (MACRA)

A federal law will change Medicare Supplement plan options for those who are newly eligible for Medicare on or after January 1, 2020.

The new federal mandate under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 affects all private insurers nationwide. This mandate states that Medicare Supplement plans can no longer cover the cost of the Medicare Part B deductible for those who first become eligible for Medicare on or after January 1, 2020. Therefore, as of that date, we’ll no longer offer our Medex^®´ Bronze plan to people who are newly eligible for Medicare. 

This doesn’t interfere with or change benefits for our current Medex Bronze, Choice, or Core plan members. Members already on these plans don’t need to take any action. Additionally, this new law does not impact eligibility for our employer group Medex or Managed Blue for Seniors plan options.  This only affects direct-pay Medicare Supplement plans.

Questions?
If you have any questions, please contact your account executive or visit bluecrossma.com/medicare to read more about MACRA.

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New Self-Service Reporting Tool for Accounts with 100+ Employees

We’re introducing a new claims analytics tool later this year called BlueInsights. It allows users to look up and review medical, pharmacy, and dental data through a simple, self-service interface. It will be available to all employers with 100+ employees. At that time, we’ll also retire the current ReportBlue system.

Employers that participate in the ahealthyme^®´ program will have access to select prevention and wellness reports through BlueInsights. Additionally, employers using our stop-loss tracking and reporting tool can log in to BlueInsights with the same username and password.

We’ll update you with more information about BlueInsights in the coming weeks, including how to make a smooth transition, as well as upcoming training modules. If you have questions, please contact your account executive.

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Member Months Coverage Report Available for ASC Accounts at No Cost

We’re offering a Member Months Coverage Report to our ASC accounts for the 2019 tax year at no cost. This information is required by the Internal Revenue Service (IRS) under the Affordable Care Act (ACA). Accounts are responsible for sending the report file to their tax vendor, and filing the data with the IRS.

The Member Months Coverage Report will be delivered using Secure File Transfer Protocol (SFTP), and posted in January, 2020. This new security measure enhances our ability to safeguard the personal information that’s included in these reports.

What’s Included in the Report

The Member Months Coverage Report contains data for each member enrolled for at least one month in one of our insurance plans. The report is required to include:

Date of birth Account number Group number Member number First, middle, and last name Member suffix Member Social Security Number (SSN)

Months covered for each member Dependent status Member insurance ID Member Taxpayer Identification Number (TIN) type Member TIN type Subscriber SSN Subscriber address

We won’t be soliciting SSNs. We’ll rely on accounts to update this information through the electronic enrollment file process or BluesEnroll prior to January 1, 2020

Request a Report
To request a Member Months Coverage Report, please inform your account executive before November 1, 2019.

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Important Employer Surveys: Medical Loss Ratios and Employer Group Size

In July, employers with a fully insured, premium financial arrangement with Blue Cross Blue Shield of Massachusetts will receive at least one of the following two surveys in the mail. This year, we have emphasized to our accounts that a timely response to both surveys is essential for two reasons. First, it helps us determine if the company is eligible to receive a rebate for 2019 (if any are required to be issued in 2020). Second, it ensures that employees are enrolled correctly and their claims are properly adjudicated along MSP guidelines. We appreciate your support as you encourage your accounts to respond promptly.

About the PPACA survey

The Patient Protection and Affordable Care Act (PPACA) survey allows us to accurately calculate medical loss ratios for the small- and large-employer group segments. If medical loss ratio standards are not met, premium rebates would be issued to the applicable market segment(s). We use this data, along with other components, to determine if we will need to issue rebates.

About the MSP survey

The federal Medicare Secondary Payer (MSP) survey allows us to annually track the number of employees each company has. This includes all employees, and is not limited to those associated with employers’ Blue Cross Blue Shield of Massachusetts accounts. This will help us determine whether Medicare or an employer group health plan pays for an employee’s health claims first.

How to determine which survey employers will receive:

Account Type	Survey(s)
Accounts with 125 or fewer enrolled employees	The Patient Protection and Affordable Care Act survey See the letter and survey. The Medicare Secondary Payer survey Our annual survey  determining the size of the company, based on Medicare Secondary Payer (MSP) laws See the letter and survey.
Accounts that canceled coverage with Blue Cross in 2018	The Patient Protection and Affordable Care Act survey

Questions?

For more information about these surveys, medical loss ratios, or national health care reform, please read the following resources:

Frequently Asked Questions—PPACA
Frequently Asked Questions—MSP

• • Use the intuitive search tool to find what they need, when they need it
  • Compare up to 5 results side-by-side
  • Read and write reviews on doctors
  • Search for cost estimates on approximately 1,600 common medical procedures
  • An easy view of a member’s personal profile
  • Access to Summary of Health Plan Payments/Explanation of Benefits statements
  • The ability for members to view their co-insurance and deductible amounts for certain services
  • An easy, new way to look up medications covered by the plan
  • Adverse medication risk
  • Opportunity to coordinate care
  • Omission of essential care
  • Included at No Cost—There are no additional costs for self-insured accounts that include pharmacy benefits with the Blue Cross formulary.
  • Keeps Members Healthy—The ability to combine medical and pharmacy data to reduce medication health risks helps keep members healthy and more productive.
  • Potential Savings—Medication safety interventions as a result of the RationalMed solution can lead to healthier employees and reduced costs from claims.
  • HMO Blue Basic
  • HMO Blue $1,000 Deductible
  • HMO Blue New England Basic Copayment
  • HMO Blue New England $1,000 Deductible with Copayment Calendar Year
  • HMO Blue New England $1,000 Deductible with Copayment Plan Year
  • HMO Blue New England $1,500 Deductible with HCCS
  • Preferred Blue^® PPO $500 Deductible with HCCS

Changes to Specialty Pharmacies and Updated Medication List

Effective July 1, 2019, we’ll implement the following changes to our retail specialty pharmacy network and to the medications these pharmacies can fill.

AllianceRx Walgreens Prime Will Leave Our Retail Specialty Pharmacy Fertility Network

AllianceRx Walgreens Prime will no longer participate in our retail specialty pharmacy fertility network. If a member is receiving specialty fertility medications through AllianceRx Walgreens Prime, they can complete the medications for their current cycle, but we won’t cover prescriptions filled at AllianceRx Walgreens Prime on or after July 1, 2019. We’ll communicate directly with all members impacted by this change.

BriovaRx^®´ Will Leave Our Fertility Network, But Remain in Our Specialty Network

BriovaRx will no longer participate in our fertility network, but will stay in our Specialty Network. Members who are receiving fertility medications through BriovaRx can complete the medications for their current cycle, but we won’t cover fertility prescriptions filled at BriovaRx on or after July 1, 2019. We’ll communicate directly with all members impacted by this change.

Updates to Our Specialty Pharmacy Medication List

We’ll cover additional medications and new-to-market medications in our specialty pharmacy network.

Medications Now Available Through Our Specialty Pharmacy Network:
Cinryze	Kalbitor
Haegarda	Ruconest
Berinert

New-to-Market Medications:
Abiraterone	Lorbrena
Alyq	Lumoxiti
Carmustine	Oxervate
Daurismo	Panzyga
Inbrija	Sofosbuvir/Velpatasvir
Ledipasvir/Sofosbuvir	Talzenna

Medications Now Available Through Our Specialty Pharmacy Network:

Cinryze

Haegarda

Berinert

Kalbitor

Ruconest

New-to-Market Medications:

Abiraterone

Alyq

Carmustine

Daurismo

Inbrija

Ledipasvir/Sofosbuvir

Lorbrena

Lumoxiti

Oxervate

Panzyga

Sofosbuvir/Velpatasvir

Talzenna

Questions?

If you have any questions, please contact your account executive.

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Upcoming Change to Member ID Cards

Beginning in June for July renewals and beyond, member ID cards will no longer include the two-digit member suffix. The new card will be issued when a member joins as a new member, requests a new ID card, changes their name, or changes their plan with us. This change to member ID cards doesn’t impact health care coverage and valid cards with or without the member suffix can continue to be used.

If you have any questions, please contact your account executive.

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Introducing the Enhanced Diabetes Eye Care Benefit

To help members with type 1 and 2 diabetes better manage their care, we have added an enhanced diabetes eye care benefit to our Blue 20/20 Exam Only and Exam Plus plans, effective July 1, 2019.  The “Enhanced Diabetes Eye Care Benefit” will include up to two diabetic eye exams and diagnostic testing within a 12-month period, at no additional cost to members. Diagnostic tests may include gonioscopy, extended ophthalmology, fundus photography, and scanning laser (offered at the provider’s discretion).

Members can find information about this benefit by visiting blue2020ma.com. 

To learn more, call your Blue Cross Blue Shield of Massachusetts account executive.

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Introducing Our New Medication Lookup Tool

With our new and improved Medication Lookup tool, members, prospective members, and providers can easily determine which medications are covered by our plans. They can also find covered alternatives to non-covered medications, as well as which medications have additional requirements before being prescribed. Members, prospective members, and providers can use this tool to:

• Search for any medication
• View medications by strength
• See medications by how they’re dispensed, such as pills, liquids, and injections
• Learn which medications have additional requirements, such as Prior Authorization, Step Therapy, and Quality Care Dosing
• See covered alternatives for non-covered medications
• View medications by tier*

Go to Medication Lookup Tool on May 23 to use the new tool.

If you have any questions, please contact your account executive.

*A medication’s tier is based on the plan design. Knowing how many tiers a plan has can help the member understand their out-of-pocket costs. Instructions to find which plan the member has are included within the tool.

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Support for Members Affected by Midwest Flooding

In response to the recent Missouri River flooding, we are expediting access to care for members who live in affected areas of Iowa and Nebraska.

Through our national Blue Card plan, we provide health care coverage for people across the country, including nearly 1,400 members in affected areas of Iowa and Nebraska. In the wake of the severe flooding, we are working to ensure that members can access health services and medications quickly and in locations convenient to them.

For our members living in affected counties of Iowa and Nebraska, effective immediately, we are:

• Allowing early refills of prescription medications
• Waiving referral, authorization, and pre-certification requirements for medical and pharmacy services
• Offering medical and behavioral health visits through Well Connection, our telehealth platform, free of charge, with no copayments or deductibles.

Affected members should call Member Service for details.

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Safely Dispose of Expired or Unwanted Drugs on April 27, 2019

Medications don’t last forever. Over time, their chemical properties change, making them less potent—and even dangerous. The U.S. Drug Enforcement Administration’s next National Prescription Drug Take Back Day is Saturday, April 27, 2019, from 10:00 a.m. to 2:00 p.m.

Encourage your employees to go through their medicine cabinets and check for any unused or expired medications—this includes everything from aspirin to prescription drugs. Anyone can take part, by bringing their expired or unused medications to a local disposal location.

To find Take Back locations, please use the U.S. Drug Enforcement Administration's search tool.

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Updates to Our Employer Website

We want to let you know that we’ve added several improvements to our website for Employers. These updates will enhance the user experience and enable additional capabilities in the future.

These updates include:

• Improved look and feel, with an updated navigational menu
  Ensures consistency with our member website and best practices.
• New search functionality
  Easily find the information you’re looking for.
• Better optimization for mobile devices
  Content adapts to the screen size of mobile phones and tablets.

To provide a clear understanding of these enhancements, we’ve created a webpage that shows you what’s new. View the updates now. 

If you have any questions, please contact your account executive.

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Enrollment Kits and Benefits@Blue Changes for Small Group Accounts

Starting January 14, 2019, electronic enrollment kits (eKits) and our customized Benefits@Blue websites will be generated automatically for small group accounts in the Inside Sales and Small Groups - 25–50 segments. Broker agencies will no longer need to request these items.

Shortly after each account’s renewal date, we’ll send a link to a personalized eKit and a link to the Benefits@Blue website to the account’s primary contact on file. With these tools, accounts will have 24/7 access to helpful plan education and information, such as plan summaries, SBCs, fact sheets, and links to other resources that align with a specific account’s plan.

If you have any questions, please contact your account executive.

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Account Toolkit for Split-Level Cost Sharing for Diagnostic Tests and Imaging Services

As communicated in our 2019 Product and Benefit Updates brochure for small employers, effective January 1, 2019, upon renewal, we'll apply two cost-share levels for outpatient Diagnostic Tests and Imaging Services on certain Merged Market medical plans. This change will not apply to Blue Options plans, Blue Select^® plans, Connector plans, and plans with Hospital Choice Cost Sharing.

If your plan will include this benefit update on renewal, please help your enrolled employees learn about this important benefit change.

Download and distribute these educational member support materials:

Email template – Boost awareness with copy you can email to your employees.

Fact Sheet – Empower your employees to save money, with a PDF you can print and distribute.

Poster – Promote "Why Pay More" with this poster to display in high-traffic areas.

Webpage – Drive engagement by linking to bcbsma.info/whypaymore.

If you have questions, please contact your account executive.

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New Change to HMO and Blue Choice (POS) Plans That Could Reduce Your Costs

To help lower costs for employers and members, Blue Cross and Blue Shield may negotiate lower, out-of-network claims costs for covered services performed by out-of-network Massachusetts providers. This change takes effect in 2019 and applies to all employers with commercial HMO and POS plans.

Negotiations between us, or a contractor working on behalf of Blue Cross and Blue Shield, and out-of-network health care providers may take place after a claim is made. If negotiations are successful, the out-of-network provider will then be reimbursed the new, lower amount.

Reducing the claims costs for out-of-network claims may decrease employer payments and member out-of-pocket costs. For self-funded plans, the administrative services account agreement provides that when the related claims services described above result in a claim savings to the Account, Blue Cross and Blue Shield will charge the Account an amount equal to 30% of the claim savings. Savings are calculated as the difference between the original allowed charge and the newly negotiated reimbursement amount.

At this time, fee negotiation for HMO and POS plans will only apply to non-participating providers in Massachusetts. In the future, this practice may expand to include out-of-state non-participating providers. Blue Cross and Blue Shield will update our website to reflect changes in this practice as they occur.

If you have any questions about this change, please contact your account executive.

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New Identity Protection Products for Members

Beginning December 1, 2018, Experian is replacing its ProtectMyID and Family Secure products with IdentityWorks Credit 1-Bureau for adults, and IdentityWorks Minor Plus for dependents under 18. Eligible members already enrolled will need to re-enroll anytime between December 1, 2018, and the expiration date of their current Experian product to avoid a gap in no-cost identity protection.

We'll update the member fact sheet and MyBlue content to reflect these changes, and Experian will send an email to currently enrolled members, letting them know how to continue receiving services.

As a reminder, employers and members aren't charged for this voluntary service, and the cost of this program to Blue Cross doesn't cause premiums to increase.

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Blue 20/20 Plan Now Includes a Discount on Hearing Exams and Aids

We now offer a discount on hearing exams and aids for Blue 20/20 plan members through Amplifon Hearing, an independent company. In addition to receiving vision care coverage, Blue 20/20 members will now have an affordable option for discounts on hearing exams and aids. Members can visit amplifonusa.com/blue2020 or call 1-866-921-5367 to speak to an Amplifon Patient Care Advocate. Learn more.

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We're Partnering with Virgin Pulse®´´ to Encourage Employee Health and Well-being

In 2018, Blue Cross and Virgin Pulse joined forces to launch two new programs, focused on promoting better health and well-being in the workplace. We unveiled ahealthyme^®´ Rewards, a fully-funded turnkey wellness program that allows employees to earn rewards for making healthier choices every day. In addition, we rolled out Healthy Together, a four-week challenge offering that motivates employees to team up and conquer fun virtual fitness challenges.

Based on the success of these two programs, we’re excited to build on our partnership with Virgin Pulse in 2019 to offer:

• ahealthyme Rewards– the expansion of our flagship program will give additional accounts access to the fee-waived core option of ahealthyme Rewards, while others will have access to this turnkey well-being program as a premium buy-up.
  Program Availability
  Fee-waived Core: Fully insured (100-499)
  Buy-up Alternative: Fully insured (500+); Self-insured (100+)
• Enterprise Solution—an alternative premium buy-up to the traditional ahealthyme program, designed to maximize the partnership between Blue Cross and Virgin Pulse. Expanding on the elements of ahealthyme Rewards, participants in Enterprise Solution can earn points by taking advantage of their Blue Cross benefits. The program also allows for a degree of personalization, ensuring your program is a perfect fit for your company—and your employees.
  Program Availability: Self-insured (500+)
• Healthy Together Well-being Challenges—four weeks of team-based challenges that take employees on virtual adventures around the world, while encouraging them to get active, build camaraderie, and make healthy lifestyle choices together. 
  Program Availability: Fully insured (500+); Self-insured (100+)

Ready to learn more? Contact your Health Engagement team or account executive for details on program availability, enrollment information, and more.

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With New Website Design, Promoting ahealthyme Rewards Is Even Easier

Our redesigned ahealthyme Rewards website means a whole new level of convenience and simplicity for HR managers. You’ll find everything you need to spread the word about your new wellness program and engage your employees at ahealthymerewards.com/employerportal.

Once you’re on the page, you’ll see that all the promotional pieces for the program have a new look, tone, and feel. The updated design highlights:

• The key benefits of the program for your employees
• The cash rewards they can earn, simply by making healthier choices
• The ease of signing up and getting on the path toward leading a healthier, happier lifestyle

We’ve brought a new level of simplicity to our website, too. All the marketing assets for the program—from challenge emails to fact sheets–are displayed on the home page with a thumbnail and a description next to each. Now, promoting your wellness program and helping your employees earn up to $400 per year are just one click away.

Have questions about your existing program or interested in signing your company up for ahealthyme Rewards at your next renewal? No problem—contact your Health Engagement team or account executive to learn more.

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New Health Education and Engagement Services Through Wellness Concepts

We’re excited to announce that beginning January 1, 2019, our health education and engagement services will expand significantly to incorporate a wide range of new topics and events, including:

• Seminars, live webinars, and recorded videos, such as: nutrition education, mindfulness, and financial education (webinar only)
• Health fair offerings, such as: nutrition counseling with body fat testing, meditation, aromatherapy, Wellness Jeopardy, and honey tasting
• Physical activity classes, such as: healthy cooking demonstrations, yoga, Pilates, and kickboxing

We’ve developed these additional on-site programs to help enhance our members’ physical, emotional, financial, and social health and well-being. To learn more about our expanded offerings, or to schedule an event, please contact your Health Engagement team or account executive.

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No-Cost Flu Vaccine Available for Members

We're committed to helping limit the spread of the flu this season. That’s why we cover the cost of flu vaccines like the flu shot for members ages six months and older, and now the nasal spray flu vaccine (for specific populations) for the 2018-2019 flu season, when administered at any of the following locations:

• Health care professional’s office
• In the member’s home (if administered by a home health care provider)
• Limited services clinic (like a CVS MinuteClinic®´)
• Urgent care center
• Community health center
• Public access clinic sponsored by cities and towns
• Hospital outpatient department

For more flu-related information, visit bluecrossma.com/flu. If you have questions, contact your account executive.

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Help for Members Affected by California Wildfires

As deadly wildfires continue to burn in California, Blue Cross Blue Shield is committed to providing support to all of our members who live in affected areas. To expedite access to care, we're adjusting the following policies for members in impacted areas, including:

• Allowing early refills of prescription medications
• Waiving referral, authorization, and pre-certification requirements for medical and pharmacy services in areas that have been declared federal disaster zones
• Offering medical and behavioral health visits through Well Connection at no cost, with no copayments and no deductibles

Questions or Concerns?

You can call Member Service at the number on your ID card or 1-800-262-2583. You can also call our 24/7 Nurse Care Line at 1-888-247-2583 to talk to a registered nurse.

•  

Safely Dispose of Expired or Unwanted Drugs on October 27, 2018

Medications don't last forever. Over time, their chemical properties change, making them less potent—and even dangerous. The U.S. Drug Enforcement Administration's next National Prescription Drug Take Back Day is on Saturday, October 27, 2018 from 10:00 a.m. to 2:00 p.m.

Encourage your employees to go through their medicine cabinets and check for any unused or expired medications—this includes everything from aspirin to prescription drugs. Anyone can take part, by bringing their expired or unused medications to a local disposal location.

To find Take Back locations in your area, please use the U.S. Drug Enforcement Administration's search tool.

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Help for Members Affected by Hurricane Michael

Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of Florida.

To help expedite access to care, we're adjusting the following policies for members in impacted areas:

• Allowing early refills of prescription medications
• Waiving referral, authorization and pre-certification requirements for medical and pharmacy services in areas that have been declared federal disaster zones

If Members Have Questions or Concerns

Members can call Member Service at the number on their ID cards or 1-800-262-2583. They can also call our 24/7 Nurse Care Line at 1-888-247-2583 to talk to a registered nurse.

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Prepayment Inpatient Claim Review

As previously communicated in a June IAI, we've partnered with Equian, a nationally known payment integrity vendor, to help continue to manage costs and improve the accuracy of claim payments. Blue Cross has a broad spectrum of programs throughout the healthcare system targeted at identifying and mitigating costs associated with high dollar claims. This partnership adds to that spectrum by enhancing our pre-payment review process for certain high dollar inpatient claims. This enhanced review process began on April 1, 2018 for fully insured accounts, and ASC accounts will be included effective January 1, 2019, upon renewal.

You don't need to take any action to be included in this process. Qualified claims will be automatically identified for review. There will be no impact on members. For more information, please contact your account executive.

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Expanded Fitness and Weight-Loss Reimbursement Benefits

Effective upon renewal starting January 1, 2019, we'll expand the definition of qualifying programs for our Fitness and Weight-Loss Reimbursements. This will provide more options for members who use these types of programs and reward them for a broader range of healthy behaviors.

Qualified Fitness Programs

Our Fitness Reimbursement will expand to cover instructor-led group classes at fitness studios. Members will be able to get reimbursed for membership and class fees at:

• Full-service health clubs with a variety of exercise equipment, including cardiovascular and strength-training equipment
• Starting in 2019—Fitness studios that offer instructor-led group classes for cardiovascular and strength training, such as yoga, Pilates, kickboxing, indoor cycling, and other exercise programs

Qualified Weight-Loss Programs

Our Weight-loss Reimbursement will expand to cover online or in-person weight-loss programs with services that align with National Institutes of Health (NIH) guidelines for choosing an effective weight loss program. Members will be able to get reimbursed for participation fees at:

• Hospital-based programs and Weight Watchers^®' (in-person)
• Starting in 2019 — Weight Watchers online and non-hospital programs (in-person or online) with a combined focus on healthy eating, exercise, and counseling with a certified health professional

New Forms and Online Submission for Reimbursements

We're creating new forms for reimbursement requests that will include the expanded reimbursements.

^®' Registered Marks are the property of their respective owners.

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Help for Members Affected by Hurricane Florence

Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Florence. We're committed to providing support to all members who live in affected areas of the Carolinas and Virginia. To help expedite access to care, we're adjusting the following policies for members in impacted areas:

• Allowing early refills of prescription medications
• Offering medical and behavioral health visits through Well Connection, our telehealth platform, free of cost, including copayments and deductibles. Affected members simply need to use the code "FLORENCE" on the payment screen to waive the cost of a visit through September 27.
• In addition, we will waive referral, authorization and pre-certification requirements for medical and pharmacy services in areas that have been declared federal disaster zones

If Members Have Questions or Concerns

Members can call Member Service at the number on their ID cards or 1-800-262-2583. They can also call our 24/7 Nurse Care Line at 1-888-247-2583 to talk to a registered nurse.

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Important Employer Surveys: Medical Loss Ratio and Employer Group Size

In July, employers with a fully insured, premium financial arrangement with us will receive at least one of the following two surveys in the mail.

About the PPACA survey

The Patient Protection and Affordable Care Act (PPACA) survey allows us to accurately calculate medical loss ratios for the small and large employer group segments. If medical loss ratio standards are not met, premium rebates would be issued to the applicable market segment(s). We use this data, along with other components, to determine if we will need to issue rebates.

About the MSP survey

The federal Medicare Secondary Payer (MSP) survey allows us to annually track the number of employees each company has. This includes all employees and is not limited to those associated with employers’ Blue Cross Blue Shield of Massachusetts accounts.

How to determine which survey employers will receive:

Account Type	Survey(s)
Accounts with 125 or fewer enrolled employees	The Patient Protection and Affordable Care Act survey See the letter and survey. Our annual survey for the purpose of determining the size of the company based on Medicare Secondary Payer (MSP) laws See the letter and survey.
Accounts that canceled coverage with Blue Cross in 2017	The Patient Protection and Affordable Care Act survey See the survey.

Questions?

For more information about these surveys, medical loss ratio, or national health care reform, please read the following resources:
Frequently Asked Questions — MSP
Frequently Asked Questions — PPACA

We Surpassed Medical Loss Ratio Requirements for 2017

Annually, insurers are required to meet federal and state medical loss ratio requirements. Insurers who don't meet both requirements must issue rebates to all clients and members.

For the reporting year of 2017, Blue Cross Blue Shield of Massachusetts won't issue rebates, as our loss ratio exceeded state and federal requirements for all market segments

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Prior Authorization Required for Genetic Testing in 2019

Beginning January 1, 2019, Blue Cross Blue Shield of Massachusetts will require prior authorization before covering certain genetic tests. Prior authorization helps us manage costs by ensuring your employees receive services that are clinically appropriate and medically necessary. The following genetic tests will require prior authorization:

• DNA testing of hereditary heart disease risks
• DNA testing of hereditary cancer risks
• Testing to detect changes in DNA which may indicate a specific disease or condition
• Testing to help select proper medication and dosing regimens
• Prenatal screening and diagnosis of specific conditions
• DNA testing of tumor cells
• DNA sequencing to understand a current health or medical issue

Doctors who request prior authorization for these services may also suggest genetic counseling to help employees better understand the procedure and its results.

This change will only apply to members on our Commercial HMO/POS and Commercial PPO plans.

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New Electronic Benefits Enrollment Process for Businesses with 10-150 Enrolled Subscribers

We're pleased to offer a new electronic enrollment support solution for businesses with 10-150 enrolled subscribers (20+ eligible employees) to help simplify benefits administration. As a first-in-market solution, we've partnered with five leading technology platforms and three channel partners to offer a better education, shopping, and administration experience.

Get started in three easy steps:

1. Select a technology platform
2. Select a corresponding channel partner
3. Select additional benefits

For more information, click here. Talk to your broker or account executive to get started today.

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Introducing Diabetes Care Value, A New Way to Engage and Support Members with Diabetes

We're pleased to introduce Diabetes Care Value (DCV), a new diabetes management solution for our members. DCV aims to improve medication adherence among members 18 and older living with diabetes by engaging and incentivizing them to take an active role in managing their health. We'll be working with Express Scripts, Inc.^®', our pharmacy benefits manager, to offer this program. For fully-insured accounts, DCV will be included as part of our plan benefits and will launch July 1, 2018 as a one day change. ASC accounts with our pharmacy benefit may choose to opt in. Please contact your account executive for more information.

Program features include:

For Members

• Tracking and remote monitoring of blood glucose readings with a Bluetooth-enabled OneTouch Verio Flex^®' meter and the OneTouch Reveal^®' mobile app, available at no additional cost

• Access to Express Scripts' Diabetes Therapeutic Resource Center's specialty pharmacists who monitor blood glucose readings and provide tailored coaching
• Ability to opt-in to an ESI enhanced Mango Health experience. Available at no additional cost, Mango Health is a medication management smartphone app that incentivizes and rewards members for adhering to medications and making healthy choices

For Employers

• Management and support for employees with diabetes including glucose meter monitoring and clinical support from pharmacists specializing in diabetes
• ASC accounts have the option to pair DCV with Smart90^®', a convenient and cost-effective program that allows members to fill 90-day supplies of certain long-term medications through mail order or at an in-network retail pharmacy

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Introducing Prepayment Inpatient Claim Review

To help manage costs and improve the accuracy of claim payments, we've partnered with Equian, a nationally-known payment integrity vendor, to review certain inpatient claims prior to payment. Effective April 1, 2018 for fully insured accounts and January 1, 2019 on renewal for ASC accounts, inpatient claims that meet identified criteria will be reviewed prior to payment to ensure accurate reimbursement.

You don't need to take any action to be included in this new process. Qualified claims will be automatically identified for review and adjusted based on any findings.

For more information, please contact your account executive.

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Introducing Well Connection, Our New Doctor Video Visit Tool for Members

Beginning April 2, 2018, we'll be launching Well Connection, a new digital tool that lets members have live doctor video visits using their smartphone, tablet, or computer. Well Connection is replacing the telehealth platform that our members currently use. This updated service will have a refreshed look and feel, as well as a new app and website. Well Connection will use a new platform that can be seamlessly upgraded to enhance the member experience.

We'll inform members who have already registered for Telehealth in advance of the change. Then on April 2, they'll receive email communications with a link to the Well Connection website prompting them to reset their current Telehealth password. Some basic member information will be transferred to the new platform when resetting the password. The current Telehealth app and website will still be available for members to access previous records, but they can only visit with providers using the new Well Connection app and website.

Marketing materials for accounts will be available on BlueIQ beginning in April.

We look forward to working with you to bring these exciting changes to our accounts and members.

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Introducing the Future High-Cost Member Report for ASC Accounts

Beginning mid-March 2018, we'll introduce the Future High-Cost Member report, available to our ASC accounts. This is an enhancement to the Early Notification Authorization report that uses new predictive modeling logic in addition to the existing high cost authorization methodology to include members who are likely to incur $50,000 or more in claims over the following 12 months. This new report will also explain information in easy-to-understand language.

If you have any questions, please contact your account executive.

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New Massachusetts State Mandate - Contraceptives

On Monday November 20, 2017, Governor Baker signed into law the contraceptive ACCESS bill (An Act advancing contraceptive coverage and economic security in our state).  This bill is effective May 20, 2018, and mandates coverage for the following contraceptive methods and services for females, with no cost sharing:

• Food and Drug Administration (FDA)-approved contraceptive drugs, devices and other products (excludes male condoms). If the FDA has approved one or more therapeutic equivalents of a contraceptive drug, device or product, plans are not required to cover all therapeutically equivalent versions as long as at least one is included and covered without cost sharing.
• FDA-approved emergency contraception available over-the-counter.
• Voluntary female sterilization procedures.
• Patient education and counseling on contraception.
• Follow-up services related to the drugs, devices, products and procedures listed above including, but not limited to, management of side effects, counseling for continued adherence and device insertion and removal.

Dispensing requirement: The law also stipulates that contraceptives can be dispensed for an initial fill for a 3-month period and then, a 12-month period for any subsequent dispensing of the same prescription which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered person was enrolled in the policy, contract, or plan at the time the prescription contraceptive was first dispensed

Who does this apply to?

This mandate applies to insured commercial plans, except an employer that is a church or qualified church-controlled organization can be exempt from providing contraceptive coverage upon request. An employer that invokes the exemption due to religious reasons has to provide written notice to prospective employees, prior to enrollment in the plan, listing the contraceptive health care methods and services for which that employer will not provide coverage. However, coverage for these contraceptive drugs, devices, products and procedures must be provided when prescribed by a provider for a reason other than contraceptive purposes, including but not limited to decreasing the risk of ovarian cancer, eliminating symptoms of menopause or necessary to preserve the life or health of the subscriber or the subscriber’s spouse or covered dependents.

How does this apply to your health plan?

Since all non-grandfathered plans (self-insured and fully-insured) are currently required by the Affordable Care Act (ACA) to provide coverage for FDA-approved contraceptive drugs, devices and products with no cost sharing, no changes are required to comply with this requirement.

Grandfathered fully-insured plans that are not a church or church-controlled employer, will need to update their contraceptive services coverage to comply with the state law and provide coverage with no cost sharing on anniversary or after May 20, 2018.

Plans will also be updated to include the dispensing requirement for all fully insured plans.

For additional details or any questions, please contact your account executive.

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ASC Invoices Going Paperless

Beginning in March, Administrative Services Contract (ASC) accounts will receive billing packet invoices by email only. January paid month 2018 invoices will be the final hard copy we send to ASC accounts. Going forward, we'll email monthly invoices as PDFs no later than the seventh business day of each month.

Our new electronic invoice delivery process will result in:

• Increased Security—Information will be protected through our secure encryption software.
• Paper Reduction—We'll reduce the impact on our environment.
• Time Savings—ASCs will receive electronic PDF statements as soon as they're ready, helping to better manage their accounts and avoid delayed payments.
• Easier Sharing—Sort, save, and share PDFs.

Questions?

If you have any changes to your contact information please email ASCInvoicing@bcbsma.com. For any other questions please contact your Blue Cross Blue Shield of Massachusetts billing representative.

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Important Updates Coming to the MyBlue Member App

We're excited to announce upcoming changes to the MyBlue Member App. Throughout 2018, we'll be making several enhancements that offer our members a better user experience, improved performance, and full integration with the MyBlue website.

The first phase of the MyBlue Member App upgrade will include:

• Enhanced performance
• Streamlined registration and Touch ID
• New visual designs
• Easy and secure log in
• The ability to view, print, email, and download ID cards

The MyBlue Member App will continue to be an easy-to-use tool that gives each member a secure and convenient way to manage their health plan using their smartphone or tablet. The updates won't disrupt current features, such as:

• Doctor visit, claims, and prescription history
• Copay information
• Financial account balances
• Find doctors and hospitals
• Directions to medical offices, urgent care clinics, and MRI facilities

Starting in mid- to late-January, the phase 1 enhancements will be available by download through the iTunes^® and Google Play^™app stores. We're asking all users to re-register their account in the app once the update is installed.

We'll continue to update you when new enhancements and releases are available. In the meantime, if you have any questions, please contact your account or sales executive.

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New "My Pharmacy Options" Program for Commercial Accounts with Pharmacy Benefits

Starting January 1, 2018, Express Scripts^®' will begin a promotional mailing campaign encouraging the use of mail service delivery. Members taking a medication suitable for the mail service pharmacy will receive a letter explaining the benefits and potential savings of the mail service pharmacy program.

To learn more about My Pharmacy Options, contact your account executive.

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Upcoming Changes to Summary of Health Plan Payments Statements

Due to new requirements issued by the Massachusetts Division of Insurance, beginning February 1, 2018, we'll send updated Summary of Health Plan Payments statements to members. We're updating the glossary of terms and adding language regarding member privacy, delivery options, and suppression rights.

These changes will impact members of all fully-insured and self-insured commercial accounts, student health plans, and guest plans. Medicare and dental plans won't be impacted by this change.

We'll also be updating our Summary of Health Plan Payments Guide, the privacy notice in our Subscriber Certificates, and our Commitment to Confidentiality notice.

If you have any questions, please contact your account executive.

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Telehealth Provider Fee Change Account Update

Our contracted provider network rates are updated periodically. As a result of a recent update, the American Well standard medical visit fee will increase by $10, to $59. This impacts our discounted member rate, increasing it from $39 to $49 effective on January 1, 2018.

We're committed to providing affordable health care to you and your employees. Our Telehealth offering is very competitive in the health care market, and is a cost-effective alternative to non-emergency, in-person care. Telehealth adds value to your benefits package by offering your employees state-of-the-art, convenient, and secure access to care through a national network of credentialed providers, anytime and anywhere.

Please contact your account executive with any questions.

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BCBSMA To Launch New Prescription Drug Product For ASC Accounts

We are pleased to announce the introduction of Smart90, a new 90-day at retail pharmacy product, for our ASC clients beginning in 2018. With Smart90, your employees benefit by paying the same amount for a 90-day supply of a certain long-term medications at a CVS retail pharmacy as they do through the Express Scripts^®' (ESI) mail service pharmacy.

To learn more about Smart90, please contact your Account Executive.

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Walgreens Specialty Pharmacy Is Now AllianceRx Walgreens Prime

One of the specialty pharmacies in our retail network, Walgreens Specialty Pharmacy, has changed its name to AllianceRx Walgreens Prime. AllianceRx Walgreens Prime delivers specialty pharmacy services to individuals with complex medical conditions.

If your employees are already using this specialty pharmacy for any medication, no action on their part is required. AllianceRx Walgreens Prime will continue to fill prescriptions under its new name. Phone and fax numbers will remain the same, but the website has been updated to reflect the name change.

How to reach AllianceRx Walgreens Prime:

• Phone: 1-800-649-2872
• Fax: 1-800-935-0719
• alliancerxwp.com

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Introducing ahealthyme Rewards, the wellness program that rewards healthy decisions.

We're pleased to introduce our new wellness incentive program, ahealthyme Rewards, powered by Virgin Pulse^®', an independent company. ahealthyme Rewards is available to fully insured accounts with a renewal date of January 1, 2018, that have 100-249 subscribers. This program is fully funded by Blue Cross.

ahealthyme Rewards helps Blue Cross subscribers improve their health and well-being, while helping your company expand its culture of health. Program features include:

For Subscribers

• A free Max BuzzTM health tracker
• Up to $400 annually in rewards per subscriber
• Personalized, digital experience based on subscribers' health and well-being goals
• Motivational team and individual health challenges

For Employers

• Better health among participating employees, translating into improved productivity, improved culture of well-being, and fewer sick days
• A pre-packaged wellness solution with minimal administration
• A robust communications toolkit that contains everything necessary to promote the program to their employees
• Engagement reporting

For more information regarding the program, click here: ahealthyme Rewards account brochure.

Please direct all questions to your Blue Cross Account Executive.

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Your Employees Are Getting Access to More Dentists

Beginning January 1, 2018, Dental Blue^® members will be able to get service from nearly 122,000 dentists, and 300,000 provider locations across the country through our Dental Blue National Network. This new network is one of the largest in the country, and is nearly twice the size of our current national network. To support this endeavor, we'll be issuing new ID cards to existing members in November. In addition, we've updated our Find a Doctor & Estimate Costs tool, making it even easier for your employees to search for network dentists and locations. They can now search seamlessly using a zip code or plan type. Your employees will no longer have to conduct a separate search for dentists outside of Massachusetts.

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Limiting Spread of the Flu Virus

The flu can best be prevented with the current flu vaccine, which is updated annually to most closely match recent viral strains. At Blue Cross, we're committed to helping limit the spread of the flu virus. Experts recommend annual vaccines every flu season for everyone 6 months or older. We partner with doctors, hospitals, workplaces, and pharmacies to make it more convenient for our members to get their flu shots.

Members can receive a flu vaccine at any of these locations:

• Primary care provider's office
• Nurse practitioner's office
• Physician assistant's office
• Specialist physician's office
• Certified nurse-midwife's office
• Limited services clinic (e.g., MinuteClinics^® at CVS)
• Urgent care center
• Community health centers
• Home health care provider (in the member's home or at a flu clinic hosted by a home health provider)
• Member's worksite (if administered using a Blue Cross Blue Shield of Massachusetts contracted vendor)
• Public access clinic sponsored by cities and towns
• Outpatient department of a hospital

For the 2016-2017 flu season, the CDC recommends against using the nasal spray flu vaccine, commonly supplied as FluMist. As a result, Blue Cross Blue Shield Massachusetts won't cover this type of vaccine for the current flu season.

For more information about preventing and treating the flu, visit our Flu Facts page on MyBlue.

Please contact your account executive for more information on approved vendors or to schedule a workplace-based flu clinic.

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Low-Cost Generic Drug Benefit

Did you know that if your plan includes a mail service pharmacy benefit, covered employees can get a 90-day supply of select generic medications for only $9 when filled through Express Scripts?

For more information on our mail service pharmacy or to view a list of $9 generic medications, visit bluecrossma.com/mail-service-pharmacy.

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Blue Cross Blue Shield of Massachusetts Surpasses Medical Loss Ratio Requirements for 2016

The Patient Protection and Affordable Care Act requires insurers to meet specific medical loss ratio standards. This standard for large groups is 85 percent, which means that at least 85 percent of every premium dollar goes toward medical expenses, while the corresponding federal standard for small groups and individuals is 80 percent. In Massachusetts, however, the requirement for small groups and individuals (or merged market) is even higher-it's 88 percent.

Under Massachusetts law, if an insurer's medical loss ratio is below the requirement, the company must issue rebates to the companies and people they insure. Blue Cross Blue Shield of Massachusetts won't be issuing rebates, as our loss ratio exceeded both state and federal medical loss ratio standards for all market segments subject to medical loss ratio regulations. We're proud to have surpassed the requirements by ensuring that more than ninety cents of every dollar goes toward paying medical expenses for our members.

Learn more about the medical loss ratio at HealthCare.gov or mass.gov.

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Support for Our Members Impacted by Hurricane Irma

Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Irma. We're committed to providing support to all our members who live in affected areas of Florida and Puerto Rico. To help expedite access to care, we're adjusting the following policies for members in impacted areas:^*

• Allowing early refills of prescription medications
• Waiving referral, authorization and pre-certification requirements for medical, pharmacy and dental services
• Processing claims for services rendered by out-of-network providers at the member's in-network level of benefits

If Members Have Questions or Concerns

Members can call Member Service at the number on their ID cards or 1-800-262-2583. They can also call our Blue Care^® Line at 1-888-247-2583 to talk to a registered nurse.

If you have questions, please contact your account executive.

^*The adjusted policies will be in place for four weeks and reevaluated as necessary.

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Changes to Imaging and Sleep Management Programs for Medicare Advantage members

We're improving the management of imaging and sleep services for our Medicare HMO and Medicare PPO members in an effort to increase the quality and efficiency of these services. On January 1, 2018, we'll require prior authorization for all imaging and sleep services included in our programs. AIM Specialty Health (AIM) will manage authorizations. AIM has experience managing imaging and sleep services for our members, as well as for most other Blue plans with approximately 42 million lives under management across the country.

Medicare Advantage (HMO):

The imaging management program for Medicare Advantage HMO members will move to a full Utilization Management (UM) program for procedures that require a pre-service prior authorization. A UM program requires a Medical Necessity determination prior to the coverage of services. We'll continue to exclude certain provider groups in Massachusetts from the management process when those groups meet established criteria.

New for our Medicare HMO Blue members is a UM program for sleep services which will require a pre-service prior authorization and a Medical Necessity determination prior to coverage of services.

Medicare Advantage (PPO):

There are new requirements for Medicare PPO Blue members relating to the full Utilization Management (UM) program for both imaging and sleep services. Members are now required to get a pre-service prior authorization and a Medical Necessity determination prior to coverage of services from in-network PPO Providers.

If you have any questions, please contact your account executive.

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Support for Our Members Impacted by Hurricane Harvey

Blue Cross Blue Shield of Massachusetts is saddened by the impact of Hurricane Harvey. We're committed to providing support to all our members who live in affected areas of Texas and Louisiana. To help expedite access to care, we're adjusting the following policies for members in impacted counties in Texas and Louisiana:^*

• Pharmacy: Early refills allowed, formulary and step therapy requirements waived.
• Claims: Requirements for referrals, authorizations, and eligibility waived.
• Health and Medical Management: Any requests for referrals and authorizations will be approved.
• Finance: Premium collections will be handled on an individual account basis.

We're also pledging financial support for those impacted by the storm by making a $25,000 contribution to the American Red Cross. In addition, we're matching dollar-for-dollar, any donations made by our employees to any 501(c)(3) nonprofit organization. Matching funds will be donated to the American Red Cross and the Blue Cross Blue Shield of Texas Employee Fund.

If Members Have Questions or Concerns

Members can call Member Service at the number on their ID cards or 1-800-262-2583. They can also call our Blue Care^® Line at 1-888-247-2583 to talk to a registered nurse.

If you have questions, please contact your account executive.

^*The adjusted policies will be in place for four weeks and reevaluated as necessary.

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The Ovia™ Pregnancy App Helps Guide Our Members Through Their 9-Month Adventure

We're partnering with Ovia Health™, an independently owned and operated company, to share Blue Cross Blue Shield of Massachusetts maternity benefit information with your employees through the Ovia Pregnancy app.

Once your employees download the Ovia Pregnancy app and select Blue Cross Blue Shield of Massachusetts as their health plan, they can:

• Get timely reminders about Blue Cross maternity benefits, such as Find a Doctor & Estimate Costs tool, call-in maternity support, and a no-cost breast pump and reimbursement for childbirth classes that may be included in their plans
• Call a Blue Cross Nurse Care Manager from within the app when high-risk symptoms or conditions are reported
• Track symptoms, nutrition, weight changes, and doctor appointments
• Log milestones and learn about baby's weekly development

• To learn more about the Ovia Pregnancy app and our other maternity tools and resources available to employees and their families, visit bluecrossma.com/maternity

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Important Employer Surveys: Medical Loss Ratio and Employer Group Size

In July, employers with a fully insured, premium financial arrangement with us will receive at least one of the following two surveys in the mail.

About the PPACA survey

The Patient Protection and Affordable Care Act (PPACA) survey allows us to accurately calculate medical loss ratios for the small and large employer group segments. If medical loss ratio standards are not met, premium rebates would be issued to the applicable market segment(s). We use this data, along with other components, to determine if we will need to issue rebates.

About the MSP survey

The federal Medicare Secondary Payer (MSP) survey allows us to annually track the number of employees each company has. This includes all employees and is not limited to those associated with employers' Blue Cross Blue Shield of Massachusetts accounts.

How to determine which survey employers will receive:

Account Type	Survey(s)
Accounts with 125 or fewer enrolled employees	The Patient Protection and Affordable Care Act survey See the letter and survey. Our annual survey for the purpose of determining the size of the company based on Medicare Secondary Payer (MSP) laws See the letter and survey.
Accounts that canceled coverage with Blue Cross in 2016	The Patient Protection and Affordable Care Act survey

Questions?
For more information about these surveys, medical loss ratio, or national health care reform, please read the following resources:

• Frequently Asked Questions-MSP
• Frequently Asked Questions-PPACA

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Update to Out-of-Network Provider Claims Reimbursements for ASC PPO Plans

We're updating our standard out-of-network reimbursement benefit in order to reduce exposure to high, out-of-network charges. This update will take effect on 1/1/18 for eligible, fully insured PPO plans, and will now include eligible ASC PPO plans upon renewal in 2018.

For accounts currently offering the standard PPO out-of-network reimbursement benefit, we'll reimburse most out-of-network claims based on 150 percent of the Medicare fee schedule. When no Medicare fee is available for certain procedures, we'll use current, publicly-available fee reimbursement data, and adjust it for geographic variations to determine the fee for the claim.

Accounts currently using our standard PPO out-of-network reimbursement benefit can expect to be automatically updated to the new standard. Fully insured and ASC accounts currently offering a non-standard PPO out-of-network reimbursement rider will be given the opportunity to change to the new standard beginning 1/1/18, or discuss available non-standard rider options.

For more information, please contact your account executive.

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Earn annual discounts with Pathway to Savings: Savings made simple.

Pathway to Savings is dedicated to helping you earn annual discounts on medical premiums by packaging together medical plans with Dental, Life & Disability, and Vision & Voluntary products. This program is fully integrated into all of our product offerings, making it easier to save while still providing your employees with the most attractive coverage options. For as long as you maintain your selected ancillary products, you'll continue to save! Pathway to Savings is available to accounts with at least 50 FTE, and 30 or more subscribers.

Account Advantages include:

Easy-to-use program featuring easy to obtain savings

To save on their medical premiums, accounts must simply purchase Dental and one or more of the designated ancillary products (Life & Disability, and/or Vision & Voluntary).

All-in-one Convenience

By having your entire benefits package managed by Blue Cross Blue Shield of Massachusetts and our partner, Indigo, accounts can eliminate the headache of working with multiple vendors and insurers, and get fast support when and where they need it.

To learn more or get started in the program, please contact your Account Executive.

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We've Made Important Changes to the Indigo Website

We recently upgraded the Indigo Insurance Services website to significantly improve ease of use and drive business. Now you can find product information faster, and connect more quickly with a sales executive. Improvements to the website include:

• Mobile-friendly content and design
• Quick access to our carriers' forms
• Streamlined product information
• Expanded contact pages

To see these recent changes, go to indigo-insurance.com. We're planning more upgrades soon, and will keep you posted as they occur.

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Important Update to Blue 20/20 Plans

We want you to know about a change to Blue 20/20 that will affect your employees. We've updated coverage on our Exam-Plus and Exam-Only plans to include retinal imaging when having in-network services. This is usually an optional service that's offered by a provider during a routine exam. Your employees will have to pay a copay of up to $39 if they have this service.

If you have any questions, please contact your account or sales executive.

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Response to May 4th House vote on the American Health Care Act

Massachusetts has made historic progress in extending the security of health insurance coverage to hundreds of thousands of our fellow citizens. With a collective commitment and a spirit of shared responsibility, our state has achieved the highest insured rate in the nation, even as we strive to make care better and more affordable.

As the state's leading private health plan, we've been strong advocates for making quality health care accessible and affordable for our members, employer customers, and for those who need it the most in our community. To be clear, there can be no turning back from the coverage gains our state has made over the past decade.

We're deeply concerned that the AHCA will result in the loss of public and private coverage for millions of our fellow citizens and reduce critical federal funding to Massachusetts. As Governor Baker noted, the AHCA would "strain the fiscal resources necessary to support the Commonwealth's continued commitment to universal health care coverage." The current proposal will create increased instability in the market and undermine the ability to provide affordable and quality coverage and care to everyone regardless of condition.

We look forward to working with the governor, state legislature, our congressional delegation, other elected officials, and health care and business leaders and remain hopeful that meaningful and sustainable policy solutions can be forged on a bipartisan basis to promote a high-quality, stable, and affordable health care system for the people and employers of Massachusetts.

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New Complex Illness Management Program for Medicare Advantage Members

Beginning April 1, 2017, Blue Cross Blue Shield of Massachusetts will roll out a new in-home assistance program for Medicare Advantage members who have multiple chronic medical conditions. This program is designed to improve members' quality of life by reducing their hospital admissions and helping them maintain independence in their homes.

We're offering this program in partnership with Landmark Health, an independent company. Landmark Health will provide our members with interdisciplinary teams of doctors, behavioral health specialists, nurse case managers, social workers, pharmacists, and nutritionists that make traditional house calls.

We'll be inviting qualified members living in the following counties to participate:

• Essex
• Hampden
• Hampshire
• Middlesex
• Norfolk
• Suffolk
• Worcester

There is no additional cost to members for this program, and participation is voluntary. Members' benefits won't be affected in any way by program participation.

This program doesn't replace the primary care members are receiving. Instead, the Landmark Health team will work with members' current doctors to coordinate their overall care. Services members may receive include:

• In-home care from the Landmark Health team scheduled at the members' convenience, or when there is an urgent need
• Direct phone access to Landmark Health care team 24 hours a day, 7 days a week
• Post-discharge visits after a hospital stay to ensure transition plan is working
• Ongoing education to help members and their loved ones effectively manage complex medical needs

To enroll eligible members, Blue Cross will send out letters introducing the program and its benefits. Following the mailing, Landmark Health representatives will reach out directly to members to talk about the program.

If you have any questions, please contact your account executive. For more information about Landmark Health, visit landmarkhealth.com.

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Important Self-Insured Employer Update on PPACA Section 1557

We want to make all self-insured businesses aware of Section 1557 of the Patient Protection and Affordable Care Act (ACA) Final Rule, which was published on May 18, 2016 by the U.S. Department of Health and Human Services Office for Civil Rights (OCR). Specifically, we encourage all self-insured businesses to consult with their legal counsel on benefit designs that could potentially be viewed as discriminatory.

Section 1557 of the ACA prohibits "covered entities" from discriminating on the basis of race, color, national origin, age, disability, and sex in certain health programs and activities. The Final Rule states that any categorical exclusions of coverage for health care services related to gender transition are discriminatory. Self-insured businesses that currently exclude gender reassignment surgery have until their 2017 anniversary date to comply with this requirement. The Final Rule outlines that in investigating any complaints, where a self-insured health plan categorically excludes gender reassignment coverage, OCR will refer the matter to the Equal Employment Opportunity Commission for investigation when the self-insured health plan is not a "covered entity."

It is important to note that benefit changes resulting from Massachusetts mandates are put in place as a core benefit within all of our health plans for both fully insured and self-insured businesses. Self-insured businesses have the ability to opt-out of these Massachusetts mandates. An example of a Massachusetts mandate that imposes an age limitation on a benefit would be the requirement to cover hearing aids for all members age 21 and younger. Self-insured businesses that have reviewed their benefit and plan designs and wish to remove any limitations or opt-out of a specific mandate should contact their Account Executive to discuss modifications to their benefit design.

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Coverage for 3D Mammograms Begins in 2017

Regular screenings are the best way to find breast cancer at an early stage, when treating the disease has the highest success rates. Blue Cross Blue Shield of Massachusetts suggests that members talk to their doctor about the benefits and timing of mammogram screenings for their age and health history. In addition to coverage for standard mammography screenings, on January 1, 2017, we'll begin providing coverage for 3D mammograms (digital breast tomosynthesis), subject to the same guidelines as standard mammograms.

If you have any questions, please contact your account executive.

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Medical Policy Updates Per New State Mandates

Blue Cross Blue Shield of Massachusetts recently updated its medical policies for the treatment of Lyme disease and treatment of HIV-associated lipodystrophy, in response to two new mandates that were recently signed into Massachusetts law.

Chapter 183 of the Acts of 2016 (Effective 7/1/2016)–An Act Relative to Long-Term Antibiotic Therapy for the Treatment of Lyme Disease. Mandates coverage for long-term antibiotic therapy for a patient with Lyme disease, when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient's symptoms, diagnostic test results, or response to treatment.

Chapter 233 of the Acts of 2016 (Effective 11/08/2016)–An Act Relative to HIV-Associated Lipodystrophy Treatment. Mandates coverage for medical and drug treatments to correct or repair disturbances of body composition caused by HIV-associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, other restorative procedures, and dermal injections or fillers for reversal of facial lipoatrophy syndrome.

These policy changes were applied to all fully insured and self-insured medical plans except Medicare Advantage, as a one-day change.

If you have any questions, please contact your account executive.

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Introducing MyBlue (formerly Member Central) — a new digital member experience

This October, we launched MyBlue, formerly known as Member Central. My Blue is a personalized way for members to access their health plan information.

Starting in January, we will begin to deliver HIPAA compliant member communications to help drive awareness about the new MyBlue experience. The phased communication approach will consist of collateral updates, cross-website promotions, Healthy Times enewsletter articles, emails, social media, and text messaging.

MyBlue replaced our existing member portal, Member Central. With a simplified design, MyBlue gives members a more personalized and streamlined digital health care experience.

Simplified experience

MyBlue is all about simplicity and convenience. Using it, members can:

• Access detailed plan information (benefits, deductible)
• View Health Financial Accounts (if applicable)
• Access claims and review claims history
• Find quality care providers and estimate costs for over 1600 procedures

Personalized welcome

MyBlue recognizes each member and provides them with health plan information when they need it. For instance, messaging could include:

• Get your mammogram
• Don't forget to get reimbursed for your fitness benefit
• Save with Mail Order Pharmacy

Streamlined claims access

MyBlue securely stores and makes available all of a member's Blue Cross Blue Shield of Massachusetts claims information in one convenient spot.

• Medical
• Pharmacy
• Dental
• Vision

If you have any questions about the features and improved design of MyBlue, please contact your account executive.